What is tendinitis?
Tendinitis is the irritation of a tendon, the thick fibrous cords that attach muscle to bone. The illness causes pain and soreness just outside the joint.
While tendinitis can occur in any of your tendons, it is most common around your shoulders, elbows, wrists, knees, and heels.
Some common names for various tendinitis problems are:
• Tennis elbow
• Golfer’s elbow
• Shoulder of the pitcher
• Swimmer’s shoulder
• Jumper’s knee
Most cases of tendonitis can be successfully preserved with rest, physical therapy, and medications to reduce pain. If the tendonitis is severe and causes a tendon to tear, you may need surgery.
Types of tendinitis
Different types of tendonitis affect changed parts of the body.
Achilles tendonitis: The Achilles tendon is located between the heel and the calf muscle. Achilles tendonitis is a common sports injury. It can also be caused by shoes that don’t fit or support the foot properly. It is more likely in patients with rheumatoid arthritis.
Supraspinatus tendinitis: With supraspinatus tendinitis, the tendon around the top of the shoulder joint becomes sore and causes pain when the arm is moved, especially upward.
Some patients may find it painful to lie on the precious shoulder at night. If other ligaments in the same area are also exaggerated, the patient may have rotator cuff syndrome.
Tennis or golfer’s elbow: A common symptom of lateral epicondylitis, commonly known as tennis elbow, is pain on the outside of the elbow. It can radiate towards the wrist.
Medial epicondylitis or golfer’s elbow is pain on the inside of the elbow and is more common among golfers. The pain is most acute when trying to lift against a force. Sometimes the pain radiates up to the wrist.
De Quervain’s stenosing tenosynovitis: The sheath surrounding the thumb tendons, between the thumb and the wrist, becomes inflamed. With the clotted sheath and swelling in the area, it becomes painful to move the thumb.
Trigger finger or thumb: Finger or thumb clicks when straightened. It is fixed in a bent position because the tendon sheath in the palm is thickened and inflamed and does not allow the tendon to move smoothly. Sometimes a nodule forms along the tendon.
Wrist tendonitis: This can affect badminton players and production line workers, who repeatedly use the same wrist motion. Tendinopathy is another type of injury that affects the tendons in the wrist. This is a degenerative condition rather than inflammation.
The signs and symptoms of tendinitis tend to occur at the point where a tendon attaches to a bone and generally include:
- Pain is often described as a dull ache, especially when moving the affected limb or joint
- Mild inflammation
Causes of tendinitis
Although tendinitis can be caused by a sudden injury, the condition is much more likely due to the repetition of a particular movement over time. Most people develop tendinitis because their jobs or hobbies involve repetitive movements that put pressure on the tendons.
Using a proper technique is especially important when doing repetitive sports movements or work-related activities. Incorrect technique can overload the tendon, which can happen, for example, with tennis elbow, and lead to tendonitis.
Risk factors of tendinitis
Risk factors for increasing tendonitis include age, working at specific jobs, or joining in certain sports.
Years: As people age, their tendons become less flexible, making them easier to injure.
Occupation: Tendonitis is more communal in people whose jobs involve:
- Repetitive movements
- Uncomfortable positions
- Frequent reaching overhead
- Energetic effort
Sports: You are more likely to advance tendinitis if you participate in certain sports that involve repetitive movements, especially if your technique is not optimal. This can happen with:
Diagnosis of tendinitis
Typically, your doctor can diagnose tendonitis only during the physical exam. Your doctor may order X-rays or other imaging tests if necessary to rule out other conditions that may be causing your signs and symptoms.
Treatment for tendinitis
The goals of treating tendonitis are to relieve pain and reduce inflammation. Often, treating tendonitis on your own, including rest, ice, and over-the-counter pain relievers, can be all the treatment you need.
Medicines: For tendonitis, your doctor may recommend these medications:
- Analgesics: Taking aspirin, naproxen sodium (Aleve), or ibuprofen (Advil, Motrin IB, others) can ease the discomfort associated with tendonitis. Topical creams with anti-inflammatory drugs, popular in Europe and gradually available in the United States, can also be operative in relieving pain without the potential side effects of taking anti-inflammatory drugs by mouth.
- Corticosteroids: Sometimes your doctor can inject a corticosteroid medicine around a tendon to relieve tendonitis. Cortisone injections reduce inflammation and can help relieve pain. Corticosteroids are not recommended for tendonitis that lasts more than three months (chronic tendinitis), as repeated injections can weaken a tendon and increase the risk of tendon rupture.
- Platelet-rich plasma (PRP): Treatment with PRP involves taking a sample of your own blood and spinning the blood to separate platelets and other healing factors. The solution is then injected into the chronically irritated area of the tendon. Although research is still being conducted to determine the optimal uses, concentrations, and techniques, injection of PRP into the region of chronic tendon irritation has shown promise in the treatment of many chronic tendon conditions.
Physical therapy: You may benefit from a specific exercise program designed to stretch and strengthen the affected muscle-tendon unit. For example, eccentric strengthening, which emphasizes the contraction of a muscle while lengthening, is a very effective treatment for many chronic tendon conditions and is now considered a first-line treatment.
Surgical and other procedures: In situations where physical therapy has not resolved symptoms, your doctor may suggest:
- Dry needling: This procedure involves making small holes in the tendon with a fine needle to stimulate the factors involved in healing the tendon.
- Ultrasonic treatment: This minimally invasive procedure uses a small incision to insert a special device that removes scar tissue from the tendon with ultrasonic sound waves.
- Surgery: Depending on the severity of the tendon injury, surgical repair may be needed, especially if the tendon has detached from the bone.
Complications of tendinitis
Without proper treatment, tendonitis can grow the risk of having a tendon rupture, a much more serious condition that may require surgery.
If the tendon irritation persists for several weeks or months, a condition known as tendinosis can develop. This condition involves degenerative changes in the tendon, along with abnormal growth of new blood vessels.
Prevention of tendinitis
To reduce your chance of developing tendinitis, follow these suggestions:
- Calm down: Avoid activities that put excessive stress on the tendons, especially for long periods of time. If you sign pain during a particular exercise, stop and rest.
- Variety of exercises: If one exercise or activity causes you particular persistent pain, try another. Cross-training can help you combine an impact load exercise, such as running, with a lower-impact exercise, such as biking or swimming.
- Improve your technique: If your technique in an activity or exercise is faulty, you could be setting yourself up for problems with your tendons. Consider taking lessons or receiving professional instructions when starting a new sport or using exercise equipment.
- Stretching: Take time after exercise to stretch to maximize your joint range of motion. This can help minimize repetitive trauma to tight tissues. The best time to stretch is after exercise when the muscles warm-up.
- Use proper ergonomics in the workplace: If possible, get an ergonomic assessment of your workspace and adjust your chair, keyboard, and desk as recommended for your height, arm length, and typical tasks. This will help protect all of your joints and tendons from excessive stress.
- Prepare your muscles for play: Strengthening the muscles used in your activity or sport can help them better cope with stress and load.